HEALTH INTERVENTION OR HANDHEALTH INTERVENTION OR HAND--OUT?OUT?

Andrew Black & Scott MonaghanAndrew Black & Scott Monaghan

Bulgarr Ngaru Medical Aboriginal Bulgarr Ngaru Medical Aboriginal Corporation, Grafton, NSWCorporation, Grafton, NSW

BackgroundBackground-- Healthy food subsidy Healthy food subsidy programsprograms

Bulgarr Ngaru Fruit and Vegetable Bulgarr Ngaru Fruit and Vegetable progam and evaluation designprogam and evaluation design

Preliminary Results and ConclusionsPreliminary Results and Conclusions

USAUSA-- Special Supplemental Nutrition Program for Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Women, Infants and Children (WIC)

National program US$6.5 billion in 2009National program US$6.5 billion in 2009ParticipantParticipant s nutritional status and health outcomes s nutritional status and health outcomes improved improved Health care savings exceed program costs (in first 60 Health care savings exceed program costs (in first 60 days after birth)days after birth)

Other international programs/researchOther international programs/researchHealthy StartHealthy Start-- UK food subsidy programUK food subsidy program--launched 2006launched 2006

Improved nutritional statusImproved nutritional status-- pregnant participantspregnant participants

Supermarket Healthy Options Project Supermarket Healthy Options Project -- RCT in NZ RCT in NZ healthy food subsidies not nutrition education reduced healthy food subsidies not nutrition education reduced saturated fat (food purchases)saturated fat (food purchases)

Subsidised fruit and vegetable Subsidised fruit and vegetable program for program for disadvantaged Aboriginal families with 0disadvantaged Aboriginal families with 0--14 yo 14 yo children children Families pay $5 per week to receive $40 box of Families pay $5 per week to receive $40 box of fresh fruit and vegetables.fresh fruit and vegetables.Funding for 50 families across the five Funding for 50 families across the five communities in the Clarence Valleycommunities in the Clarence ValleyRegional initiativeRegional initiative

Galambila Aboriginal Medical Service, Coffs Harbour, Galambila Aboriginal Medical Service, Coffs Harbour, Giingan Darrunday Marlaanggu Health ClinicGiingan Darrunday Marlaanggu Health ClinicBowraville, Nambucca ValleyBowraville, Nambucca Valley

Engage families in preventive health careEngage families in preventive health careMBS Health AssessmentsMBS Health Assessments-- annuallyannuallyDental and hearing checksDental and hearing checks

Nutrition educationNutrition education-- 2 Dietitians2 DietitiansPractical cooking sessionsPractical cooking sessionsSimple seasonal recipes in F&V boxesSimple seasonal recipes in F&V boxes

Market GardenMarket Garden-- Community school gardenCommunity school garden

Strong community support for the program Strong community support for the program Positive community relationsPositive community relations

Look at what we are doingLook at what we are doingCostCost--benefit analysisbenefit analysis

Increased access to Fruit and Vegetables?Increased access to Fruit and Vegetables?

Time/Resource requirementsTime/Resource requirementslocal community, health servicelocal community, health service

DesignDesign--Pre and Post program assessmentsPre and Post program assessments

To determine the impacts of the Bulgarr To determine the impacts of the Bulgarr Ngaru Fruit and vegetable program on Ngaru Fruit and vegetable program on ChildrenChildren s nutritional statuss nutritional status

If there are nutritional benefits, are there I f there are nutritional benefits, are there any shortany short--term health benefits from the term health benefits from the program?program?

Eligibility for program:

Aboriginal families with children 0-14 years or pregnant women

Centrelink benefits as main income

Regular Bulgarr Ngaru clients

Agree to annual health assessment

Children have identified nutritional risk

Consent Y/N

Initial assessments:

24 Hour Dietary recall

Pathology test- Carotenoids, Folate, Vitamins A, C, E, Iron

Anthropometric measurements

The Program

Receive weekly box of fruit and vegetables with seasonal recipes

Nutrition promotion

Cooking classes

Follow-up assessment at 12 months:

24 Hour Dietary recall

Pathology test- Carotenoids, Folate, Vitamins A, C, E, Iron

Anthropometric measurements

Health record audit (12 months prior to and during program)

Antibiotic prescriptions

Episodes of otitis media

Episodes of pyoderma

Process evaluation

Interviews- key stakeholders

Focus groups- participants

Uptake assessed using greengrocer receipts

24 hr RecallShort

Questions

Serves Per day Fruit Vegetables

Vegetables (inc Potato) Fruit Vegetables

BeforeMean(SD)

1.0(1.4) 0.6(0.9) 0.8 (1.2) 2.2(1.0) 2.5 (1.4)

After Mean (SD)

1.0 (1.1) 0.5 (0.8) 0.7 (0.9) 2.5 (1.4) 2.2 (1.1)

(n= 115)(n= 115)

Mean(nMol/L)

Mean Difference

(nMol/L) P value

-carotenePost 339 -7.739 .630

Pre 347

-carotenePost 82 15.817 .100

Pre 66

LycopenePost 587 -50.861 .074

Pre 638

-CryptoxanthinPost 184 24.974 .027

Pre 159

Lutein-ZeaxanthinPost 338 34.470 .026

Pre 303

Red Cell FolatePost 956 192.856 <.001

Pre 763

Ascorbate (uMol/L)(n=57)

Post 60 10.474 .013

Pre 49

(n= 167)(n= 167)

MidMid--North Coast F&V programNorth Coast F&V programDemonstrated nutrition and health benefitsDemonstrated nutrition and health benefitsFruit more readily acceptable to childrenFruit more readily acceptable to children

Expensive interventionExpensive intervention-- $1820/ family/yr$1820/ family/yrFood insecurityFood insecurity

not adequately addressed by food subsidies not adequately addressed by food subsidies alonealone

Potential health benefits suggest need for Potential health benefits suggest need for a larger trial of healthy food subsidies a larger trial of healthy food subsidies

Aboriginal communities, Aboriginal communities, particularly the families particularly the families participating in the program participating in the program in the Clarence Valley, in the Clarence Valley, Coffs Harbour and Coffs Harbour and Nambucca ValleyNambucca ValleyBulgarr Ngaru, Galambila Bulgarr Ngaru, Galambila and Gingaan staff and Gingaan staff particularlyparticularly Fruit and Fruit and Vegetable committeeVegetable committee

Research teamResearch team-- Dr Hassan Dr Hassan Vally, La Trobe University; Vally, La Trobe University; Dr Peter Morris, Charles Dr Peter Morris, Charles Darwin University; Darwin University; Ms Kerry Hampshire, Ms Ms Kerry Hampshire, Ms Fiona Smith, Dr Ray Jones; Fiona Smith, Dr Ray Jones; Professor Kerin OProfessor Kerin O DeaDea--UniSAUniSA